Themes in managing culturally defined illness in the Cambodian refugee family

The Cambodian (Khmer) refugee population in America is considered to be the Indochinese refugee population at highest risk for stress-related health problems resulting from traumatic physical and emotional experiences during the Khmer Rouge holocaust in this Southeast Asian country. In this study, koucharang, described as "thinking too much," was identified by informants as a culture-bound syndrome in response to the violence experienced in Cambodia. It is characterized by behavioral changes and somatic complaints. This study identified two cultural themes used by Cambodian families in the management of this disabling condition. The research is a follow-up from a prior study that examined cultural themes in health care decision making among Khmer women. This study of themes in family management of culturally defined illness was conducted with 120 Cambodian refugee women in Long Beach, California and Lowell, Massachusetts. These geographical areas were selected because the Khmer refugee population in America has relocated primarily to the low-income inner-city areas of southern California and Massachusetts. Nursing strategies for utilizing the identified cultural themes in intervening with the Cambodian family are identified. The community health nurse can build upon the strength of these themes and the resulting culturally dictated practices as he or she provides supportive counseling and health promotion to this highly traumatized population. The emotional risks to the community health nurse in working with the Cambodian refugee family are discussed in the context of maintaining self-integrity in the face of overwhelming tragedy.